The latest HIV treatment guidelines released on Monday by the US Department
of Health and Human Services (DHHS) classify combination regimens as either
"preferred" or "alternative"--a change that could simplify therapeutic decisions
for clinicians.

The Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults
and Adolescents have been revised eight times since first being published in
1998. They are produced by a DHHS panel that meets every few months to discuss if
changes are warranted.

Previous versions of the guidelines have required clinicians to build a
regimen by selecting antiretroviral drugs from different columns of acceptable
agents. Although this method was useful at the time, the number of agents has
grown so much in recent years that such an approach has become too complicated.

The new guidelines consist of already constructed regimens that, on the basis
of trial results and expert opinion, are classified as either preferred or
alternative.

"The goal with the new guidelines was really to make it easier for clinicians
to select treatment," Dr. Anthony S. Fauci, director of the National
Institute of Allergy and Infectious Diseases, told Reuters Health. "We now have 22
different antiretroviral formulations and 19 separate drugs, which makes
selecting therapy very difficult."

"Probably the most important new aspect of the revised guidelines is that we
clearly delineate what the preferred choice is for an NNRTI-based regimen and
for a PI-based regimen," Dr. Fauci noted. "There is no more picking one from
column A, one from column B, and so on."

But the grouping of regimens according to preference is not the only new
aspect of the revised guidelines.
For the first time, "the guidelines give the pros and cons of each of the
individual components of the regimens," Dr. Fauci said. "This has not been
clearly delineated before" and it should help clinicians tailor the regimen to a
specific patient, he added.

Another difference from previous guidelines is a greater emphasis on how to
manage treatment failures. For example, the guidelines now address when it is
important to do resistance testing. "Before we were somewhat noncommittal about
that," he said.